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Anaphylaxis is an exaggerated immune response to a certain allergen. The common allergens include bee stings, peanuts, sesame seeds, latex and it may occur in individuals with known allergies or it may be a new reaction to an unknown allergen. Anaphylaxis occurs rapidly and may result in life-threatening airway obstruction as bronchospasm, and a wheeze is common. It may cause a prominent rash over the face and trunk. There may be facial swelling, bronchoconstriction, low blood pressure is common and in several cases, anaphylaxis can rapidly progress to cardiac arrest. The risk of death due to anaphylaxis is increased by those with pre-existing asthma. It is important to identify and remove the allergen, when possible. The most important drug for the treatment of anaphylaxis is adrenaline, which reverses peripheral vasodilation, reduces oedema, dilates the bronchial airways, increases the force of the myocardial contraction, and finally, it suppresses the release of histamine and other inflammatory mediators.

Adrenaline is most effective when given early. After the onset of the reaction, rapid administration of the adrenaline may prevent cardiac arrest. The symptoms include generalised rash, itching, swollen lips, tongue and eyes; breathlessness and wheezing, fainting, crampy abdominal pains, and finally, nausea and vomiting. Signs include a reduced peak expiratory flow, hypoxaemia and hypertension. To treat anaphylaxis, remove the trigger when possible. For example, remove the bee sting, give immediate IM adrenaline at the appropriate dose for the age of the patient to prevent cardiorespiratory arrest.

Repeat doses every five minutes until the patient begins to improve. Lay the patient flat elevating their legs to give a high flow of oxygen. Establish IV access and titrate IV fluids according to blood pressure. Follow standard ALS guidelines for the resuscitation of the patient with cardiac arrest. Unknown or suspected anaphylaxis including IV adrenaline, where it is not possible for IV or IR access to be established, rapidly give an IM adrenaline where a cardiorespiratory arrest has occurred recently. Treat bronchospasm as you would that of asthma, give an antihistamine to block the effects of the histamine released during anaphylaxis at the appropriate dose for the age of the patient. If the anaphylaxis is severe or life-threatening, give hydrocortisone at the appropriate dose to reduce the immune response.